新型甲型H1N1流感住院患者疾病严重程度和死亡的危险因素分析

Risk Factors for Disease Severity and Death in Hospitalized Patients with Novel H1N1 Influenza

目的分析影响新型甲型H1N1流感住院患者疾病严重程度和死亡的危险因素。方法对我院收治的92例住院患者的临床资料进行回顾性分析,比较危重症和重症组之间的临床特征,采用多变量Logistic回归分析来确定预测转归因素。结果血性痰、早期呼吸困难、免疫功能下降、低钙血症、继发感染、奥司他韦治疗初始时间、APACHEⅡ评分和△SOFA评分等因素和患者疾病严重程度密切相关。经多变量Logistic回归分析,继发感染(P<0.05,OR5.05,95%CI:1.275～25.812)、APACHEⅡ评分大于20分(P<0.05,OR1.217,95%CI:1.083～1.674)和△SOFA评分(P<0.01,OR1.136,95%CI:1.024～1.213)是住院患者死亡的独立危险因素。结论临床上应重视上述危险因素,加强对重症和危重病例的早期识别和综合治疗,以期降低病死率。

Objective To analyze the risk factors for disease severity and death in hospitalized patients with novel H1N1 influenza.Methods We retrospectively analyzed the clinical data of 92 hospitalized patients with novel H1N1 influenza and compared the clinical characteristics of patients with critical illness and those with severe illness.Multivariable Logistic regression was performed to analyze the risk factors.Results Bloody sputum,early dyspnea,decreased immune function,hypocalcemia,secondary infection,initiation of antiviral treatment with oseltamivir,APACH Ⅱ score,and △SOFA score were closely related to the disease severity.The multivariable Logistic regression analysis showed that secondary infection（P〈0.05,OR 5.05,95% CI 1.275～25.8）,APACHE Ⅱ score more than 20（P〈0.05,OR 1.217,95%CI 1.083～1.674）,and △SOFA score（P〈0.01,OR 1.136,95%CI 1.024～1.213）were the independent risk factors for the death.Conclusion For reducing the mortality of hospitalized patients with novel H1N1 influenza,the risk factors mentioned above should be taken into account.It is important to recognize the patients with critical and severe illness in the early stage.